Provider Demographics
NPI:1407720105
Name:SULSER, STEPHANIE LYNNE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:SULSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 PALOMAR DR # 1604
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8900
Mailing Address - Country:US
Mailing Address - Phone:510-603-9280
Mailing Address - Fax:
Practice Address - Street 1:1051 TENNIS LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4417
Practice Address - Country:US
Practice Address - Phone:209-740-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA692807164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse